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Wednesday, November 21, 2012

How To Treat Pneumonia

What to Do for Pneumonia

In this X-ray, pneumonia covers most of this child’s left lung (which is on your right when looking at the picture). It looks white because there’s not just air in there; there’s fluid and swollen tissue.

by James Hubbard, MD, MPH
I have a confession. I’m a pneumonia survivor. And it wasn’t walking pneumonia either. I was in the bed for a week.
Yes, a few years ago, The Survival Doctor ended up a whimpering mess, dependent on other people’s care. It took a good month to feel like doing much walking. But I was lucky. Each year millions in the U.S. get pneumonia, and over 50,000 die. In a prolonged disaster situation, that number would be much higher.
Symptoms and severity of pneumonia can vary greatly. Me, I thought I was as healthy as a horse, doing just fine, wasn’t even feeling sick. Then, out of the blue, I had a teeth-chattering chill. I just shook all over. After that, I started feeling weak, my heart beating fast. I wasn’t coughing much, but I took my temperature, and it was over 102 F.
I took a couple of Tylenol and crawled in the bed. Soon my bedclothes were soaked in sweat. After the Tylenol wore off, I had another chill. The cough started next, but I thought I had the flu. Now I wasn’t thinking right because anytime anyone comes to my office, otherwise healthy, and they’re running fever, I ask if they’ve had a shaking-all-over type chill. If they have, my first thought is pneumonia.
Well, luckily, after a couple of days of lying in the bed, my wife made me see a doctor, of all things. I mean, I am a doctor. Although he couldn’t hear much in my chest, a chest X-ray proved the diagnosis. I started on antibiotics, but it took me a good week to feel able to go back to work, and a month before I felt like doing anything like going on a walk.

How Did I Get It?

I came down with pneumonia just before my daughter Leigh Ann’s wedding. Though I didn’t have the walking pneumonia type, I managed to deliriously walk her down the aisle—and promptly get driven home to bed. I couldn’t even stay for the reception, so you know I’m not exaggerating when I say this thing can get bad.

Pneumonia can be divided into two very general types, community acquired and hospital acquired. The first is what will be more prevalent during a disaster—especially if many people are sheltering together.

Community Acquired Pneumonia (CAP)

I expect I got mine from breathing in bacteria left in the air from someone coughing. It could have been in some public place as easy as it could have been in my office.

Walking PneumoniaThere’s really no such official diagnosis as walking pneumonia. If you have pneumonia and you still feel like walking around, you have walking pneumonia. Okay, it is true that usually this milder version is caused by the bacteria called mycoplasma. And it’s usually treated with some sort of erythromycin antibiotic like azithromycin (Z-Pak) or clarithromycin (Biaxin) or some sort of tetracycline, like doxycycline.

Pneumococcal PneumoniaOne of the most common types of CAP, and the kind I probably had, is caused from the bacteria pneumococcus. We usually treat these with erythromycins or quinolones (Cipro, Levaquin, etc.).

OthersLegionnaire’s disease was first diagnosed in 1976 after several people attending an American Legion convention in Philadelphia came down with severe pneumonia. A bacteria now called legionella coming from the air-conditioning vent was isolated as the cause. The pneumonia can be severe but usually responds to erythromycin.

Pneumonia from the klebsiella bacteria is found in chronic smokers. Ciprofloxacin usually kills it.

In addition to bacteria, viruses are a common cause of CAP. Rarely a fungus can cause it.
Now, don’t get me wrong. Community acquired pneumonia can often be treated on an outpatient basis, but it can also be severe. You may need hospitalization, and people die each year from this type.

Hospital Acquired Pneumonia (HAP)

You are classified with this type if you’ve been in the hospital for more than a day or two and you get pneumonia. Many types of germs can cause HAP—things like MRSA from staph, other bacteria such pseudomonas, and fungi. HAP is usually treated with two or three different IV antibiotics. I won’t go into this type any further for the obvious reason that you won’t be seeing it out of the hospital

Pneumonia Diagnosis If You Can’t Get to a Doctor

As with my case, shaking chills and/or sweats is a clue, but high fever for any reason can cause that. Suspect pneumonia in someone who also has fever and a cough. Chest pain or discomfort is another clue, but it’s less common.
Often, if you have a stethoscope or put your ear on the person’s chest and you know what you’re listening for, you can hear crackles in an area of one or both lungs. If your hair is long enough, rub a few strands together next to your ear. That’s what one type of crackles (medical term—rales) sounds like. Sometimes rales can sound coarser.
Many people with pneumonia get short of breath with exertion. Some are short of breath at rest.

How Contagious Is Pneumonia?

Pneumonia is contagious but not highly so. When treating someone who has it, using a mask would be of small benefit. Better would be having fresh air if possible, along with taking the typical disease-prevention precautions such as washing your hands.

Treatment

It’s very hard to get an exact cause for the pneumonia even if you’re in the hospital. Fortunately, any antibiotic in the ciprofloxacin, erythromycin, or tetracycline family usually treats the community acquired type. Rest and fluids help also. Bring down the fever with acetaminophen (Tylenol) or ibuprofen (Advil).
I usually save the ciprofloxacin for smokers or those who appear pretty sick. Of course, the really sick ones—the ones short of breath who don’t respond to an asthma inhaler, the ones who can’t keep down fluids, the confused ones—I usually send to the hospital.
People with chronic diseases, such as heart disease, diabetes, or emphysema, are at higher risk for complications also, as are even healthy people over 65 and under age 2.

Prevention

The most common community acquired pneumonia is caused by pneumococcus bacteria or comes on after a bout of the flu. You already know about the annual flu vaccine, but you may not know that there’s a pneumococcus vaccine you can get every ten years. It doesn’t prevent them all, but it can cut down on your risk considerably. It’s usually recommended for people age 65 and older or who are at high risk for complications.

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